The challenges of voluntary care provision for hospitalized patients with COVID-19: A qualitative study of the public volunteers' experiences.

INTRODUCTION: During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19. METHODS: A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods. FINDINGS: The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participation and the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental trauma and physical exhaustion. CONCLUSION: Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby improving the overall quality of care provided to patients during public health crises. PATIENT CONTRIBUTIONS: Participants were identified and recruited after the study objectives were explained in person to the managers. The participants were approached and interviewed by one author. Participation was voluntary and the participants did not receive any financial compensation for their time.

Nurses' perception of troubled conscience in intensive care units: a qualitative study.

BACKGROUND: Troubled conscience results from the lack of attention to the voice of conscience. Regarding the fact that ICU healthcare workers are constantly faced with stressful and challenging situations, they often experience a troubled conscience. AIM: This study aimed to explain the factors leading to troubled conscience and identify the consequences of troubled conscience among ICU nurses. METHODS: Qualitative content analysis was used to answer the research question. A total of 18 ICU nurses were selected to participate in this study using purposive sampling. Data were collected using face-to-face, semi-structured interviews. FINDINGS: Four categories of "carelessness", "contextual challenges", "non-supportive and unpredictable structure" and "whirlpool of troubled conscience" were shown to constitute the main causes of troubled conscience among ICU nurses. CONCLUSION: Troubled conscience negatively impacts nurses and is associated with psychological/behavioral changes among them. The identification and explanation of troubled conscience help healthcare providers to confront it and manage its causes.

Encountering suffering in digital care: a qualitative study of providers' experiences in telemental health care.

BACKGROUND: Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care. METHODS: A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology. RESULTS: Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief. CONCLUSIONS: This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.

Striving to Keep a Clear Conscience by Going Above and Beyond: The Experiences of Intensive Care Unit Nurses.

Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.

Perceptions and stress of conscience in relation to burnout among nursing staff in older people care settings: a cross sectional study.

BACKGROUND: Considering cultural influences, it is important to study the perceptions and stress of conscience in different contexts. This study aimed to investigate the association between perceptions of conscience, stress of conscience, and burnout among nursing staff working in older people care settings in Tehran. METHODS: This was a descriptive, cross-sectional study. A total of 161 participants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire, and Oldenburg Burnout Inventory, 2019. All nursing staff working at the 20 contacted nursing homes agreed to participate in the study. The descriptive and inferential analysis was conducted through SPSS, using T-tests and one-way between-groups analysis of variance, Chi-square and t-tests, Cohen's d (d), Eta-squared (η2), and Phi coefficient (φ), Partial least squares regression (PLSR), jackknife approximate t-tests of the regression coefficients, and jackknife 95% confidence intervals of the regression coefficients. RESULTS: The nursing staff perceived their conscience mainly as an authority, asset, and warning signal. Impact of workload on family life was the most common source of stress for the nursing staff. Dealing with incompatible demands, the impact of workload on family life, witnessing insulated patients, inability to meet one's standards in providing care, and perception of conscience as a burden were strongly associated with the burnout. CONCLUSIONS: Perceiving conscience as a warning signal or authority may serve as a buffer against burnout among nursing staff. This study highlights the need for further exploration of perceptions of conscience in different cultural and social backgrounds.

Intensive care unit nurses' conflict of conscience: Walking the Razor's edge.

The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.

Factors affecting Iranian nurses' intention to leave or stay in the profession during the COVID-19 pandemic.

AIM: This study was conducted to explore the factors affecting nurses' intentions to leave or stay in their profession during the coronavirus pandemic in Iran. INTRODUCTION: Because the effectiveness of a healthcare response to a disaster depends on an available, skilled, and motivated healthcare workforce, it is essential to understand and address potential barriers to and reasons for the intentions of medical staff to leave or stay in their profession. METHODS: A qualitative study with a conventional content analysis approach was conducted. The participants included nurses working in hospitals during the COVID-19 pandemic, and nurses who had previously left their job or had been absent from work for a period of time. The participants were selected using a purposeful sampling strategy. Data were collected through 19 in-depth, individual semi-structured interviews with 16 nurses. The COnsolidated criteria for REporting Qualitative research checklist was used to report the study. FINDINGS: Three categories; commitment and work conscience (with a subcategory of risk-taking), fear (with two subcategories of fear of family infection and fear of protective equipment shortages), and organizational factors (with two subcategories of organizational atmosphere of the hospital and motivational factors), emerged from the analysis. CONCLUSION: The reasons for quitting a nursing job or to keep working as a nurse during the pandemic include both personal and organizational factors. Commitment and work conscience in pandemic conditions is one of the main factors for keeping nurses in their profession. IMPLICATION FOR NURSING PRACTICE AND POLICY: Gaining insight into nurses' understanding of the situation and perspectives is the key to being able to provide appropriate support and keep them in the workforce. Peer support can play an important role in supporting novice nurses in facing challenges posed by a pandemic and should be improved. Also, programs and strategies need to be planned to improve resilience among nurses and to help them to manage their stress and fear.

Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.

INTRODUCTION: A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses. AIM: To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran. METHOD: The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation. RESULTS: The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver. CONCLUSIONS: The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden.

BACKGROUND: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts. RESEARCH OBJECTIVE: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia. RESEARCH DESIGN: A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33-46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential. FINDINGS: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day. CONCLUSION: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.

Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff.

BACKGROUND: Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden. METHODS: An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis. RESULTS: Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff. CONCLUSIONS: The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver.

Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions.

BACKGROUND: While many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses' experiences of pain assessment in a surgical ward. METHODS: A cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data. RESULTS: Nurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients' self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients' pain. CONCLUSIONS: Thai nurses worked based on a 'patient-evidence' paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients' self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field.

Experiences of dementia in a foreign country: qualitative content analysis of interviews with people with dementia.

BACKGROUND: Dementia is a worldwide health concern of epidemic proportions. Research in the field of subjective experience of dementia suffers from a lack of diversity of their participants including immigrants. Different portraits of life with dementia could help us understand how people with dementia conceptualise their experiences of dementia and how they live. Our study aimed to explore the subjective experiences of living with dementia among Iranian immigrants in Sweden. METHODS: Qualitative content analysis of interviews with fifteen people with dementia from Iranian immigrant backgrounds were conducted (8 females and 7 males). RESULTS: Three themes and seven associated sub-themes were revealed. The themes included: Being a person with dementia means living with forgetfulness (personal sphere), living with forgetfulness in the private sphere means feeling incompetent but still loved, living with forgetfulness in the public sphere means feeling confident and secure but also isolated. CONCLUSIONS: Living with dementia for the participants meant living with forgetfulness. They experienced feeling incompetent but still loved within their families and feeling confident and secure but also isolated in the society. Educating people with dementia and their families about the course and process of dementia may help them understand the changes better and adjust their expectations. Our study can provide a basis for healthcare workers to understand the experiences of living with dementia from this specific perspective.

Distant suffering: A concept analysis.

BACKGROUND: Patients who are suffering may be commonly encountered in health care. The growing use of telehealth implies that encounters with patients who are suffering may increasingly take place at a distance. "Distant suffering" is a concept coined within sociology to describe the suffering of far-away others. It is conceptualized as a paradox, as distance changes the relation between the witness of suffering and the suffering encountered. Impacts may include a potential detriment to the sufferer and ethical implications for the witness. OBJECTIVE: To explore the concept of distant suffering and any relevance, implications, or important avenues for potential research within the healthcare sciences. DESIGN: Rodgers' evolutionary concept analysis. DATA SOURCES: Databases of Web of Science, Medline, CINAHL and PsycInfo were searched for the terms "distant suffering" or "mediated suffering". REVIEW METHOD: Attributes, surrogate or related terms, antecedents, consequences, and uses of the concept were extracted and synthesized. RESULTS: Thirty articles published within the past ten years were selected for review from the search results. "Distant suffering" was characterized as comprising 1) mediated far-away suffering, 2) a "recognizer" or witness, and 3) a potential role of a moderator. Antecedents include shared understandings and socially-influenced responses. Consequences include responses like empathy, compassion, pity, also indifference, cynicism and compassion fatigue. CONCLUSIONS: Further research to explore distant suffering from healthcare sciences' perspective could uncover valuable insights for those suffering, for healthcare workers, and any who are exposed to it. An improved understanding of how distant suffering is conveyed and moderated could enable targeted reduction of exposure or improve response to distant suffering. Such knowledge could help diminish negative consequences for those suffering, for healthcare workers who are caring at a distance for those suffering, or for others who encounter distant suffering in their occupations or in daily life via media, social media, or digital communications. TWEETABLE ABSTRACT: New analysis finds that exposure to distant suffering may have important implications for health and health care.

Experiences of living with dementia: qualitative content analysis of semi-structured interviews.

AIMS AND OBJECTIVES: To describe people's experiences of living with dementia in Iran. BACKGROUND: A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses' ability to provide adequate and meaningful care. DESIGN: Qualitative, cross-sectional design. METHODS: Qualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60-87 years old). RESULTS: The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility. CONCLUSION: Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience. RELEVANCE TO CLINICAL PRACTICE: The results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.

Surgical Nurses' Perceptions of Strategies to Enhance Pain Management Proficiency: A Qualitative Study.

To describe surgical nurses' strategies for enhancing their pain management proficiency. A qualitative design was used to conduct the study. The participants were forty surgical nurses who had at least six years of nursing experience in caring for patients with pain. They responded to open-ended questions based on a review of the policy documents concerning the main elements of the pain management programme to be implemented by surgical nurses. Three key themes emerged from the surgical nurses' suggested strategies: partnering, disrupting, and becoming familiar with pain management competency concerns. Surgical nurses' strategies in acute and chronic pain management nursing units included solving patients' problems and promoting and enhancing pain strategies to address health challenges in organisations. The themes presented in the results include enhancing pain management in nursing competencies. State-of-the-art healthcare technologies are being applied to pain management. Surgical nurses' strategies should improve the quality of nursing care, especially post-surgery recovery time. It is recommended to engage patients, their families, and multidisciplinary care teams in other healthcare fields.

Core components of an effective pain management education programme for surgical nurses: A Delphi study.

PURPOSE: This study aimed to describe the core components of an effective pain management education programme (PMEP) for surgical nurses in Thailand. METHODS: A three-round Delphi method was used. A panel of 40 experts advised regarding the essential components of an effective PMEP for surgical nurses. RESULTS: The core components of a PMEP were derived from experts' panel consensus: (i) multidisciplinary collaboration, (ii) acquisition of innovative knowledge and training by healthcare teams, and (iii) consideration of individual differences when delivering pain management services. To enhance their pain management practices, nurses should adopt multimodal pain approaches that involve family roles and engage in active patient listening. CONCLUSIONS: The PMEP designed in this study, which adheres to international nursing training standards, promotes the competency of professional nurses.

Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies.

BACKGROUND: A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women's experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. METHODS: Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. RESULTS: Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. CONCLUSION: When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.

Nurses' Experiences of Caring for Patients With Suspected or Confirmed COVID-19 in the Initial Stage of the Pandemic.

Introduction: Nursing staff have faced various challenges during the global pandemic of COVID-19 such as nursing shortages. The great number of COVID-19 patients requiring hospitalization placed heavy demands on healthcare staff to maintain patient safety and to work according to constantly changing guidelines to prevent the spread of infection. Objective: The objective was to describe nurses' experiences of caring for patients with suspected or confirmed COVID-19 in the initial phase of the pandemic. Methods: The study has a qualitative design. Semi-structured interviews were conducted with seven nurses in primary care and hospital care during the initial stage of the pandemic. Qualitative content analysis with an inductive approach was used. Results: The nurses expressed that the working routines changed very quickly at the onset of the pandemic. A triage system was implemented to care for patients with symptoms of COVID-19 to prevent transmission between patients. A major change was the constant use of personal protective equipment in patient care. The nurses also experienced a sense of inadequacy regarding the care of the patients and became emotionally affected and exhausted. Conclusion: The nurses experienced that many patients worsened clinically, leading to exhausting and difficult nursing care situations. They also experienced increasing responsibility since new protective equipment and procedures needed to be quickly implemented according to frequently changing recommendations, causing the nurses to feel uncertain about how to maintain patient safety. Support from colleagues was crucial to cope throughout the initial stage of the pandemic.